Individual
MATTHEW NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2115
(417) 820-5344
Mailing address
PO BOX 504274, SAINT LOUIS, MO 63150-4274
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2012020969
MO
207P00000X
Emergency Medicine Physician
5101017953
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538315072
—
MO
01
—
440552485
TRICARE
MO
01
—
P01116113
RR MCR
MO
Enumeration date
08/15/2008
Last updated
03/01/2013
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